The present invention relates to an instrument and method for passing a medical implement, such as suture or similar element, through tissue.
The insertion of a medical instrument or implant through tissue can involve the application of significant mechanical force. For example, the insertion of a suture through thick connective tissue requires substantial pressure, regardless of whether the suture is pushed or pulled through the tissue. In an open surgical procedure, the exposure of the large surgical incision provides access for manipulation and visualization. Nevertheless, insertion can still be problematic. Furthermore, it is often desirable to minimize the size of this incision to reduce scarring and soft tissue trauma.
Arthroscopy and other minimally invasive surgical procedures utilize small incisions or portals for insertion of diagnostic and surgical instruments manipulated externally of the body, and therefore, avoid the trauma associated with large incisions as well as the hospitalization and prolonged recovery periods required with open surgery. While it is not always required, an endoscope may be used to enhance visualization. However, due to the small surgical incision of these minimally invasive approaches, it is frequently difficult to gain the access required to insert and manipulate the instrument or implant. Remotely passing a suture through tissue can be one particularly troublesome task.
The prior art teaches a number of devices attempting to solve this problem. For example, the Carter-Thomason suture passer disclosed in U.S. Pat. No. 5,496,335 has a sharp tip that opens and closes so that the tip can both grasp the suture and penetrate through tissue. However, this instrument, like most, if not all, relies solely on mechanical force to pass the suture through tissue.
Thus, there exists a need for an improved suture inserter and method.
The present invention relates to a method of passing a medical implement having a magnetic component through tissue. The medical implement is placed on a first side of the tissue, a magnetic field is established on a second side of the tissue, and at least one of the magnetic component and magnetic field is manipulated to drive the medical implement through the tissue. In one embodiment, the magnetic component is a portion of the medical implement. Alternatively, the magnetic component can be attached to the medical implement.
The magnetic component can be made of a magnetizable material, or can actually be a magnet, either a permanent magnet or an electromagnet. Regardless of the nature of the magnetic component, the magnetic field location can be altered to provide directional control of the medical implement as it is driven through the tissue. In an exemplary embodiment, the medical implement is made of a non-magnetic matrix and the magnetic component is dispersed within the matrix material. The matrix can be a resorbable material, with the magnetic component comprising a plurality of iron particles.
The present invention also relates to a surgical instrument for delivery of an implant through tissue. The implant has a body, a carrier located on the body for removeably securing at least a portion of the implant to the instrument, a tip located at a distal end of the body and configured and dimensioned for insertion through the tissue, and a magnetic element located on the body. Interaction between the magnetic element and a magnetic field external to the tissue drives the instrument through the tissue.
The magnetic element can be part of the body or attached to the body. The magnetic element can be a permanent magnet or an electromagnet. Regardless, the magnetic element can be movable to provide directional control of the instrument as it is driven through the tissue.
The invention also related to a suture passer for inserting a suture through tissue. The suture passer includes an elongate body having proximal and distal ends, a first jaw disposed on the distal end of the body and having a first magnetic element, and a second jaw disposed on the distal end of the body and having a second magnetic element. At least one of the first and second magnetic elements is an electromagnet and the other can be made of a magnetizable material. A handle is disposed on the proximal end of the body for manipulation of the suture passer and a controller is provided for operating the electromagnet. The first and second jaws are movable relative to each other from a closed position to an open position and one of the polarity and strength of the electromagnet is changed to move the first and second jaws to the open and closed positions.
In one embodiment, the first jaw has a piercer for penetrating the tissue and the second jaw has an opening for receiving the piercer. The handle can be operated to move the first and second jaws to the open and closed positions. The piercer can be provided with an opening for receiving the suture so that the suture can be passed through the tissue after the piercer has penetrated the tissue. In an exemplary embodiment, the first magnetic element is the piercer and the first and second jaws are slideable with respect to one another to vary the angle the piercer is inserted through the tissue.
In another embodiment, the first jaw has a clip for holding a suture needle. Again, the handle can be operated to move the first and second jaws to the open and closed positions.
Both the first and second magnetic elements can be electromagnets. Accordingly, the first and second electromagnets can be selectively activatable and deactivatable to move an implant back and forth through tissue. A mechanical stop can be provided on either or both of the jaws to removeably secure the implant to the jaw. The mechanical stop can be either independent of the controller for the electromagnet or can be operated by the controller.
In use, a suture needle, with suture attached thereto, is removeably secured to the first jaw of the suture passer. A portion of the body of the suture passer is inserted through an incision in a patient so that the first and second jaws are located adjacent the tissue. The first and second jaws are separated to the open position so that the first jaw is on a first side of the tissue and the second jaw is on a second side of the tissue and the controller is operated to move the first and second jaws to the closed position so that the needle tip penetrates the tissue. After the needle penetrates the tissue, the needle can be released from the first jaw; and pulled through to thereby pass the suture through the tissue. If desired, the needle can be removeably secured to the second jaw to pass the needle back and forth through the tissue.
The suture passer can also be used by providing the first jaw with a piercer for penetrating the tissue and providing the second jaw with an opening for receiving the piercer. At least a portion of the body of the suture passer is inserted through an incision in a patient so that the first and second jaws are located adjacent the tissue. The first and second jaws are separated to the open position so that the first jaw is on a first side of the tissue and the second jaw is on a second side of the tissue. The controller is operated to move the first and second jaws to the closed position so that the tip penetrates the tissue. The suture is then fed through a bore in the piercer.